Overview

Ligaments are strong bands of tissue that connect bones to each other. The capsule is thinner tissue that encloses the shoulder joint and may include certain ligaments.

Shoulder sprains may be caused by:

• falling on an outstretched arm
• forced twisting of the arm
• a blow to the shoulder

Risk factors that increase your chances of spraining your shoulder include:

• playing sports
• poor coordination
• poor balance
• inadequate flexibility and strength in muscles and ligaments
• loose joints

Diagnosis

Symptoms of a shoulder sprain include:

• pain, tenderness and swelling around the shoulder
• redness, warmth or bruising around the shoulder
• limited ability to move the shoulder and increased pain with movement

The doctor will ask about your symptoms and how you injured your shoulder. The doctor will examine your shoulder to assess the stability of the joint and the severity of the injury.

Tests may include:

• x-rays — to make sure that no bones are broken
• magnetic resonance imaging (MRI) scan — to see the extent of damage to the soft tissues of the shoulder (rarely needed)

Shoulder sprains are graded according to their severity:

Grade1

• stretching and microtearing of ligament and capsular tissue

Grade 2

• partial tearing of ligament and capsular tissue
• mild instability of the joint

Grade 3

• severe or complete tearing of ligament and capsular tissue
• significant instability of the joint

Treatment Options

Treatment includes:

• rest
  Avoid using your injured arm.
• ice
  Apply ice or a cold pack to the shoulder for 15-20 minutes, 4 times a day for at least 2 to 3 days. This helps reduce pain and swelling. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
• compression
  Wrap your shoulder in an elastic compression bandage (e.g., Ace bandage). This will limit swelling and pain.
• medication

  Take one of the following drugs to help reduce inflammation and pain:

  • ibuprofen (Motrin, Advil)
  • naproxen (Aleve, Naprosyn)
  • acetaminophen (Tylenol)
  • aspirin
• brace or sling
  You may need to wear a sling to immobilize your arm and shoulder. If you play sports, you may need to wear a shoulder brace when you return to play.
• rehabilitation exercises
  Begin exercises to restore flexibility, range of motion, and strength in your shoulder as recommended by your health care professional.
• surgery
  Surgery is rarely needed to repair a shoulder sprain. However, surgery is often needed to repair a ligament and capsule that are torn completely.

Prevention

Many shoulder sprains cannot be prevented. To reduce your risk of spraining a shoulder:

• Do exercises to strengthen arm, back, and chest muscles.
• Learn the proper technique for exercise and sporting activities. This will decrease stress on all your muscles, ligaments and tendons, including those around your shoulder.

Shoulder sprain rehabilitation

As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important. Rehabilitation for a shoulder sprain often includes the following:

• rest during the acute phase
• ice injury multiple times per day
• compression of the injured shoulder with an elastic compression bandage (ACE bandage) to limit swelling and pain
• use anti-inflammatory medications such as ibuprofen to reduce inflammation and speed up recovery

Most shoulder sprains can be rehabilitated with a sling to immobilize your arm and shoulder. You also may be required to wear a shoulder brace temporarily when you return to your sport. These devices help hold the shoulder in place while the sprain heals. Your doctor also may prescribe rehabilitation exercises once the sling is removed.

The major objectives of rehabilitation from a shoulder sprain are to increase flexibility, achieve pain-free range of motion, and strengthen the muscles of the shoulders, upper back, front chest, and upper arms. In severe cases, you should avoid activity that causes shoulder pain altogether. In these cases, you can still maintain cardiovascular fitness by cycling, unless otherwise prescribed by your doctor.

Surgery is rarely needed to repair a shoulder sprain. However, it may be needed to repair a ligament and capsule that are torn completely.

Keep in mind that rehabilitation for a severe shoulder sprain may be different in these instances. In these cases, your doctor may prescribe special physical therapy and recovery time will vary.

Rehabilitation exercises

Rehabilitation exercises often prescribed by your doctor may include:

• Shrugs
  Stand with hands at sides with no weight in either hand. Raise shoulders to the point of pain and hold for five seconds. Relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, hold dumbbells of equal weight in each hand while performing this exercise. Add weight by using hand-held dumbbells as pain permits.
• Bicep curls
  Stand with arms fully extended at sides while grasping 2- to 5-pound weights in each hand, held palm forward. Flex the arms at the elbow to approximately 100 degrees, or to the point of pain, whichever comes first. Hold this position for 5 to 10 seconds. Return to the start position. Rest for 5 seconds. Repeat this exercise 10 times. You can increase the weight as pain allows and strength develops.
• Triceps curls
  Stand with elbows directed upward over the shoulders and with arms relaxed. Extend arms at the elbow so that the hands proceed upward to the point of pain. Hold this position for five seconds. Return to the starting position and relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, add weight by using hand-held dumbbells.
• Chest raises
  Lie on belly with hands extended along sides of the body. Raise the upper chest from the floor to the point of pain and hold this position for 5 seconds. Return to the start position and relax for 10 seconds. Repeat this sequence 10 times, 3 times daily.
• Saws
  Reach out and place the unaffected side hand on a corner of a table. Bend at the waist. Flex the injured side arm at the elbow and pull the injured side arm backward and upward as if sawing wood. Slowly bring the shoulder blades as close together as pain will permit. Slowly bring the injured side arm down to its beginning position. Repeat this sequence 10 times, at least three times daily.
• Pendulum swings
  Stand with the hand of the unaffected arm resting on the corner of a table and supporting some of the body weight. Slightly bend the knee on the unaffected side and extend the other leg sideways. Allow the injured arm to hang loosely over the unaffected side foot. By shifting the body weight, cause the relaxed injured arm to swing in circles to the fullest extent possible as limited by pain. Perform 25 swings in a clockwise direction. Allow the injured arm to cease swinging. Perform 25 swings of the injured arm in a counterclockwise direction. Repeat this sequence at least three times daily.
• Shoulder rotation
  Stand in a doorway with affected side arm bent at the elbow and the palm of the hand against the doorframe. Turn the body away from the injured side hand until a stretching sensation is experience in the injured shoulder. Hold this position for 10 seconds. Return to the starting position. Relax for 10 seconds. Repeat this sequence 10 times at least 3 times a day.
• Shoulder flexion
  Stand erect close to a wall. With the palm of the injured side arm turned so as to face you, slowly slide the forearm and then the upper arm up the wall by moving closer to the wall. Slide the arm upward to the point of initial significant pain. Hold this position for 10 seconds. Return to the starting position and relax for 10 seconds. Repeat this sequence 10 times, at least 3 times daily.
• Towel stretch
  Roll a towel lengthwise. While standing erect, dangle the rolled towel down the back, holding it with the unaffected side hand. Reach behind the back with the hand of the injured side and grasp the rolled towel. Gently pull upward on the towel, raising the injured side arm until first significant pain in the injured shoulder appears. Hold this position for 10 seconds. Relax the arms while maintaining the grasp on the rolled towel for ten seconds. Repeat this sequence 10 times at least 3 times daily.
• Flexed elbow pull
  Bend and raise the injured side elbow to shoulder height. Grasp the injured side elbow with the uninjured side hand. Gently pull the injured side elbow toward the opposite shoulder until limited by first significant pain. Hold this position for 10 seconds. Relax for 10 seconds. Repeat this sequence 10 times at least 3 times daily.

Alternative exercises

During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:

• water running
• stationary bicycle (add resistance gradually from one session to the next, as pain allows)

Rehabilitation after surgery

Very rarely, surgery may be needed to repair a shoulder sprain. However, it may be needed to repair a ligament and capsule that are torn completely. In these cases, you will need to wear a sling or figure-of-eight strap while you heal.

When your doctor decides you are ready, you may start range-of-motion and strengthening exercises. You may be referred to a physical therapist to assist you with these exercises, and under no circumstance should you return to sports activity until your shoulder is fully healed.

A physical therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills.

How long will the effects of the injury last?

To some extent, the time to fully recover from a shoulder sprain is influenced by your dedication to your rehabilitation program. Typically, athletes require anywhere from 2 to10 weeks of healing time, depending on the severity, before returning to their sport.

When can I return to my sport or activity?

Return to full participation should be avoided until your shoulder sprain has healed and you can perform all skills and other requirements of your sport without pain.

Remember: the goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your shoulder sprain recovers, not by how many days or weeks it has been since your injury occurred.